65121D - Kelly

6kMA / ❑ DREDGE & FILL
"ENERAL PERMIT Previous permit #
few ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (° / ules attached.
Name/�
�h,C f `
r
State ZIP Z..
Fax # () ..-
ad Agent
11 CW SEW ❑JPcrA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑FC:
yes / no PNA n") no Crit.Hab. yes / no
Project Location: CountyIA&_fz 4214m e/
Street Address/ State Road/ Lot #(s) ,l
-7 / `4 �! Issas" % /l/jT��l wk,
Subdivision C "Aw itTlLl� -
City W,I/N+l ass -/?1r ZIP 2�t/
Phone # ( ) River Basin
Adj. Wtr. Body nat
Closest Maj. Wtr. Body-y�%�ii �'C taGrl
' Project/ Activity �d rr S fins/A", �'',� �'`�Gf-'' ,' ,%!2''�Cl�
(Scale: �� y
length I
X 5�3,65
:ngth
tubbee
r
d/ Riprap If
g distance <
ax distance
hannel
ibic yards
mp
use/ Boat
3ulldozing
.et
ne Length
not sure yes C:
gs: not sure yes
mum: n/a yes
yes
Attached: yes r��
Ping permit may be required by: Vl7 ttowT U See note on back regarding River Basin
e L

DENR CAMA Daily Check Log for WIRO
Date
Check
Check
Received
Check From (Name)
Name of Permit Holder
Vendor
Number
amount
I Permit NumberIC
3/2/2015 Pacula Builders LLC
Roy Gilbert & Brenda Madison
First Citizens Bank
1138
$600.00 GP 65079D
3/2/2015 Pacula Builders LLC
Dennis Michael
Security Savings Bank
1847
$400.00 GP 65102D @$20(
Dennis Michael
GP 65103D @$20(
3/2/2015 David Lee Builders, Inc
Edwards
B of A
19918
$100.00 minor fee, TB 154.
3/3/2015 Carolina Marine Construction, Inc.
John Clark
First Bank
9496
$400.00 GP 65093D
3/3/2015' East Coast Engineering & Surveying, P.C.
Dinah Gore
First Bank
1308
minor fee, SB 15-0
3/412015,Hunter Development Corp.
John Ledoux
Yadkin Bank
22714
__$100.00
$200.00 GP 65037D
3/5/2015 Coastal Marine Piers Bulkheads LLC
James Harren
Wells Fargo Bank
20059
$100.00 renewal fee, MP 11
3/5/2015 Mark D. Kelly
same
PNC Bank
795
$200.00 GP 65121D

IC Division of Coastal Mgt. Habitat impact Computer Sheet
� I/ / F
pplicant: �A� K D ! e t l Permit #. S /Z 1
ate:
3 /s jls
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Fund in your Habitat code sheet.
abitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
mp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fina
disturbance.
Excludes any
restoration and/c
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Others
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/BAIOORIXG PILIAGS/BOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
,, / 401
ame of Property Owner)
property located at Z 2 /v /fl►` NFLW6nl l\(e
I
(Lot, Block, Road, etc.)
on C+4 ANNEL "— 4\tE1 , in t✓v I L N? I t'16T© Tl� , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (15') from my area of riparian access unless waived by me.
(If you wish to waive the setback, you must initial the appropriate blank below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
r�oATIN6
�Ql ja"r�L
/-�oC./<
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writi
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at'[phone],
No response is considered the same as no obiection if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
JV G 12 CAI ANt sEi .
Mailing Address
(Riparian )?Xoperty Owner Information)
4Kv, "
W I _Lt At r)yTo 0 N C- 2.�4-My v v
City/State/Zip JPrint o6ppe Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIA100RTVG PILIAGS/BOATLIFTIBOATIIOUSE)
I hereby certify that I own property adjacent to I�Aw 4, `l_5 J is
,, / (Name of Property Owner)
property located at L / 2—v /GqANN,!!�k HAVEN b%2
/ (Lot, Block, Road, etc.)
on aPNtJ6L �AVE —,in fit//1.M1A1GT o /1 N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (15') from my area of riparian access unless waived by me.
(If you wish to waive the setback, you must initial the appropriate blank below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
f oR Tl Abc
�o
50
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writi
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at'[phone],
No response is considered the same as no obiection if you have been notified by Certified Mail
(Information for Property Owner/Applicant (Riparian Property Owner Infor ation)
Applying for permit) � 7/7
L � z IV CYAAvNEL A{,qk/G /V �%�
Mailing Address
/ Signature
:�0, L-t I,"'e//
City/State/Zip
Print or Type Name

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